Healthcare Provider Details

I. General information

NPI: 1215873187
Provider Name (Legal Business Name): LARISSA ROEHL WERNECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEADOWMONT VILLAGE CIR STE 202
CHAPEL HILL NC
27517-7518
US

IV. Provider business mailing address

170 MANNING DRIVE CAMPUS BOX 7025
CHAPEL HILL NC
27599-7025
US

V. Phone/Fax

Practice location:
  • Phone: 984-974-4401
  • Fax:
Mailing address:
  • Phone: 919-966-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: